This week, the Department of Health Care Services (DHCS)
published
quality ratings and imposed monetary sanctions on Medi-Cal
managed care plans (MCPs) that do not meet required performance
levels. The new MCP model contract took effect on January 1,
2024, and seeks to strengthen quality and health equity
requirements for MCPs.
Additionally, for the first time, DHCS released
quality ratings for county behavioral health plans, based
upon performance. This is the first year DHCS is releasing
quality scores for county behavioral health plans, but there are
no sanctions being issued to these plans.
DHCS is issuing quality measure ratings for Measurement Year (MY)
2022 for all MCPs and county behavioral health plans to help
drive improvement in support of greater plan engagement and
outreach to ensure the medical needs of Medi-Cal members are
prioritized, especially preventive care and primary care services
that promote health and well-being.
Eighteen of the 25 MCPs will be fined due to performance rates
below designated Minimum Performance Levels (MPLs). For MY 2022,
MCP sanctions ranged from $25,000 to $890,000 based upon factors
that include the eligible population impacted, the degree to
which a plan fell below MPLs, the degree of improvement or
decline from the previous MY, and the plan’s Healthy Places Index
(HPI) score for assigned membership to that plan.
For county behavioral health plans, counties overall performed
well on mental health quality measures, with 71% of counties
meeting MPLs on at least half of the mental health measures
related to follow up after emergency department visits and
hospitalizations related to mental illness, and management of
antidepressant medications. County performance was similar on
substance use disorder (SUD) measures, with 80% of counties
meeting MPLs for at least half of the measures related to follow
up after emergency department visits for SUD, use of
pharmacotherapy for opioid use disorder, and initiation and
engagement with SUD treatment.
Under their contract with DHCS, all plans (both MCPs and county
behavioral health plans) are required to meet the DHCS
established MPLs for each Medi-Cal Managed Care Accountability
Set (MCAS) performance measure.
